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If you believe King County Public Hospital District No. 2 is responsible for harm or loss because of negligent actions by the District or its past or present officers, employees or volunteers, you may submit a claim for payment. The District is required by chapter 4.96 RCW to receive these claims. Some information in the form is subject to public disclosure pursuant to chapter 42.56 RCW.
Download a Claim Form
Download one of these two forms:
Complete the Claim Form
- Complete and sign the claim form according to the directions in the form
- Claim form must be signed by the Claimant or his/her guardian or attorney at law or in fact
- Gather all documents that support your claim
- Keep copies of everything you submit as documents will not be returned
Present the Claim to the District
Option 1 – Submit Claim by Email
- Email completed and signed claim with supporting documents to claims@evergreenhealth.com
- Include the claimant's name in the subject line of the email
- Include your name and contact information in the body of the email
- Email attachments (the claim form and supporting documents) should be in PDF format
NOTE: EMAIL IS NOT A SECURE METHOD OF DELIVERY. The District is unable to ensure that personal health or other confidential information received by email is secure according to applicable privacy laws. You should not submit any personal health or other confidential information to the District by email. If you attempt to submit an email and receive email notification that the message exceeds the domain's maximum per-message size limit, you should try to reduce the size of the message and resend it or submit your claim by mail or in person. Your email submittal must include the date and time the claim document was submitted.
Option 2 – Submit Claim by Mail
Mail completed and signed claim with all supporting documents to the District at the following address
EvergreenHealth
Attn: Executive Assistant to the CEO
12040 NE 128th Street, MS #14
Kirkland, WA 98034
Option 3 – Submit Claim in Person
Deliver completed and signed Claim with all supporting documents to the District's administrative offices, between 8 a.m. to 5 p.m., Monday through Friday (except holidays), located at
EvergreenHealth
Attn: Executive Assistant to the CEO
12040 NE 128th Street
Kirkland, WA 98034
District staff cannot provide legal advice; consult your attorney with questions
Services of Process
The Executive Assistant to the CEO is authorized to accept service of process for King County Public Hospital District No. 2 d/b/a EvergreenHealth in the District's administrative offices, located at 12040 NE 128th Street, Kirkland, WA 98034.
